Addiction and DSM-5

If you are a non-medical person (like me) understanding how the DSM categorizes different forms of addiction, can be very confusing.

What is the DSM?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard used to classify mental disorders. It is used by doctors and mental health professionals in the United States. The DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. New disorders are studied and added continually. The latest version is the DSM-5. The previous version was the DSM-IV. The only reason I point that out, is that they have decided to drop the roman numerals and use numbers, from now on. 

Doctors use the DSM-5 to diagnose their patients and to request reimbursement from insurance organizations. This is noteworthy, since insurance companies are now required to cover substance abuse the same way they cover other diseases.

Another important role of DSM is to establish diagnoses for research on mental disorders. Only by having consistent and reliable diagnoses can researchers determine the risk factors and causes for specific disorders. This helps them determine their frequency and prevalence rates.

Here is a link to the recent changes in the DSM-5

To simplify things, I will list things that have been added (to the DSM manual) that relate to substance abuse and addiction.

Body Dysmorphic Disorder

Hoarding Disorder

Trichotillomania (Hair-Pulling Disorder)

Excoriation (Skin-Picking) Disorder

Substance/Medication-Induced Obsessive-Compulsive and Related Disorder (Obsessive-Compulsive and Related Disorder Due to Another Medical Condition)

Other Specified and Unspecified Obsessive-Compulsive and Related Disorders. This can include conditions such as body-focused repetitive behavior disorder and obsessive jealousy, or unspecified obsessive-compulsive and related disorder.

Gambling Disorder

An important departure from past diagnostic manuals is that the substance-related disorders chapter has been expanded to include gambling disorder. This change reflects the increasing and consistent evidence that some behaviors, such as gambling, activate the brain reward system with effects similar to those of drugs of abuse and that gambling disorder symptoms resemble substance use disorders to a certain extent.

Note: DSM-5 does not separate the diagnoses of substance abuse and dependence as in DSM-IV.

There is a free training course about the DSM-V. I am going to register for it now. If you want more information click here.

Brief Review of Addictions

Addictions are repeated harmful behaviors, that continue despite negative consequences. These behaviors can include substances like alcohol, drugs, nicotine and caffeine. Addictions can also include compulsive behavior like eating, gambling, sexual activity and computer use.. 

Some signs of addiction can be thought of through the four ‘C’s:

Loss of control (feeling overwhelmed and helpless);
Compulsive use  (can’t stop.. just one more);
Cravings (immediate or urgent want of a substance or activity); and
Continued use or behaviour despite increasingly negative results (trouble with the law, missing time at work).

Most Common Addictions

Alcoholism
Gambling addiction
Drug addiction
Nicotine addiction
Exercise addiction
Sex addiction
Cannabis dependence
Heroin dependence
Sedative dependence

Some Less Common Addictions

Heroin addiction
Sex addiction
Alcoholism
Crystal meth addiction
Pain-killer addiction
Sleeping-pill addiction
Prescribed medication addiction
Narcotic addiction
Nicotine addiction
Caffeine addiction
Gambling addiction
Shopping addiction
Work addiction
Computer addiction
Crack addiction
Ecstasy addiction
Marijuana addiction
Cocaine addiction
Inhalant addiction
Physical addiction
Psychological addiction
Opioid addiction
Food addiction
Morphine addiction
Opium addiction
Tranquilizer addiction
LSD addiction
Oxycontin addiction
Adhesive addiction
Aerosol addiction
Solvent addiction
Online gambling addiction
Online shopping addiction
Chat room addiction
Gaming addiction

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One last note from an article published on a website called The Fix:

The DSM-5 arrives in the midst of an historic overhaul of the nation’s healthcare system under Obamacare (aka the Patient Protection and Affordable Care Act, or ACA ). Together, the legislation and the diagnostics revision are likely to dramatically increase the number of Americans eligible for addiction treatment. But the noble goal of securing more care for substance users could have an unintended consequence, some experts warn: stretching an already-overwhelmed patchwork of services past their limits.

Once Obamacare kicks in, as many as 5 million people with substance use disorder will be newly eligible for insurance, according to an Associated Press analysis. The quandary: In most states, patients already fill treatment centers to the brim. The worst-hit states have only one rehab or hospital bed available for every 100 people in need of inpatient care. The new arrivals could double the existing wait-lists.

I am not sure how this is going to play out. The law is ever-changing and constantly being challenged. What do you think?

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